Direct primary care gains traction in region
FORT COLLINS — While the cost of health care continues to increase, there appears to be little consensus over what to do about it.
The Health Care Cost Institute, a nonprofit, nonpartisan organization that provides information about health-care utilization and costs, calls the situation in this country a “profound problem” that is stifling economic growth. In October, HCCI released the results of a five-year study that showed a steady increase in spending for those with private insurance, even as the overall use of services declined.
Now, some on the front lines of health care are taking matters into their own hands.
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“Direct Primary Care, or DPC, is a model where people pay a subscription to buy their health care directly from the provider,” said Dr. John Bender, owner of Miramont Family Medicine in Fort Collins.
In the case of Miramont, that amounts to $49 a month — $39 a month if you pay yearly in advance — along with a $20 “day-of-service” charge.
“In exchange for that, a patient has access to the vast majority of services we offer,” Bender said. “Ninety-five percent of what people want when they come here, they’ll be able to get.”
Some excluded services, what Bender described as more expensive procedures, are listed in the terms and conditions.
“It’s a very simple model, but because we’re so conditioned as Americans to dealing with this horrible fee-for-service mechanism of paying for health care, people don’t understand it,” Bender said. “We don’t even bill your insurance.”
With fewer claims to clog up the system, Bender said he believes the end result will be lower premiums in general. By not billing a patient’s insurance, the DPC provider avoids additional costs, to say nothing of the hassle.
Bender gave an example of a “typical” transaction.
“Say someone comes in for a flu shot and wants to bill their insurance,” he said. “Well, that’s a $25 sale, and it’s going to cost me seven bucks to bill their insurance. Of course, the patient still has to pay the copay, so we collect the 10 bucks, and there’s still $15 outstanding — so we send the claim to (the insurance company), but they decline it because someone used the wrong code or something, so we send it back a second time, and they finally pay it. Now, someone has to update the electronic health records showing that it’s been paid.
“Meanwhile, they send us a check or electronic payment. Now, someone has to reconcile the bank account to show that it’s been received. But if the patient hasn’t met their deductible, then we have to send them a bill for the remaining $15. Now, I need an envelope and a stamp and a patient statement, and they’ll call and say, ‘I thought it was a covered service’ and someone has to tell them, ‘No, it’s not,’ and they go onto Google and write some nasty thing about us.”
A recent study published in the Journal of the American Board of Family Medicine found that DPC offered another unexpected advantage: longer office visits — 35 minutes, on average — compared with eight minutes under the traditional model.
One of the driving factors in the DPC trend has been the rising cost of insurance deductibles. The Henry J. Kaiser Family Foundation reported that, among covered workers with a general annual deductible, the average deductible amount for single coverage is $1,318. But on many plans, it can climb as high as $6,000 or more.
“The world people are trying to live in doesn’t exist anymore,” Bender said. “It was here as recently as two years ago when we had $500 deductibles and maybe a family could realistically spend that each year, but it just doesn’t happen now.”
When compared with other practices, Miramont represents a “hybrid,” Bender said. “With 30,000 patients and 84 employees, we can’t just snap the model on like a light switch, so we’re rolling it out in phases,” he said. That means Medicaid, Medicare and Tricare patients still are seen under the old fee-for-service rules, something that will continue indefinitely.
Since launching the program in September, about 300 patients have signed on, even without a significant marketing push.
“We feel that’s a very strong signal,” Bender said. “Our goal is to get to several thousand patients, at which point we won’t have to bill commercial insurance at all.
